Environmental Scan Michelle Pollock, PhD Rodger Craig, MPH Dagmara - - PowerPoint PPT Presentation

Initiatives to Improve the Timeliness of Cancer Diagnosis: Results From an Environmental Scan

Michelle Pollock, PhD

Rodger Craig, MPH Dagmara Chojecki, MLIS Bing Guo, MD, MSc CADTH Symposium April 16, 2019

Disclosure

I have no actual or potential conflict of interest in relation to this topic or presentation. The request for this project came from the Cancer Strategic Clinical Network (Alberta Health Services).

The pathway to cancer diagnosis

• Alberta has long and variable wait times to diagnosis, and

lower survival, than some Canadian provinces.

• Conventional wisdom suggests that accelerating the speed of

cancer diagnosis should improve health outcomes

The project request

• Since 2000, several Canadian and international jurisdictions

have aimed to improve the timeliness of cancer diagnosis by integrating and coordinating services across multiple components of the diagnostic interval.

• Alberta lacks a comprehensive and coordinated provincial

strategy for accelerating cancer diagnosis.

• First step was to learn what other jurisdictions have done and

see how those learnings might translate to Alberta.

“What programs currently exist, and what are they like?”

Development and implementation Structure and functioning Costs and cost savings Enablers and barriers

Project time frame: 5 months

Outcomes and effectiveness

Methods Literature review Key informant consultations

(89 documents) (20 key informants)

We conducted a two-part environmental scan: To identify and describe programs in Canada and comparable international jurisdictions (21 programs)

England Denmark Ireland Sweden Norway Wales Alberta Manitoba Saskatchewan Ontario

Size of programs

National programs Regional programs Provincial programs

24% 43% 33%

Cancer type(s) targeted

60% of programs targeted multiple types of cancer

2 4 6 8 10 12 14 16

Breast Prostate Lung Colorectal Lymphoma Other

Number of programs

Diagnostic assessment programs (rapid access clinics, fast-track clinics) Care pathways (standardized care pathways, patient pathways

Type of programs

57% 43% Specify the type of care to be offered at each stage of the diagnostic interval Organize access to coordinated and comprehensive diagnostic services in a single place

Program components

2 4 6 8 10 12 14 16

Centralized and coordinated diagnostic services Patient navigators Wait time targets Urgent referral criteria Multidisciplinary teams Pre-booked appointment slots Parallel booking

• f diagnostic

services "Straight-to-test" access to diagnostic services for primary care providers

Number of programs

Do the programs… decrease wait times?

Consistent, robust, statistically significant improvements observed across multiple: ✓ Types of programs ✓ Countries ✓ Cancer types ✓ Comparator groups ✓ Time points within the diagnostic interval In almost all cases, wait time reductions spanned several days to weeks.

Do the programs… improve the patient experience?

When data were available, patients reported mostly positive experiences across: ✓ Both types of initiatives ✓ Multiple countries ✓ Multiple cancer types ✓ Different comparator groups

Do the programs… increase early-stage diagnosis and long-term survival?

In most cases, patients seen through the programs showed No difference in cancer stage at diagnosis and No difference in survival at one, two, three, or five years compared to other patients.

Costs

• Funding received for program implementation
• Funding received for program maintenance
• Cost and/or resource savings

Enablers

✓ Clear rationale for program development ✓ High-level support and funding ✓ Building on existing initiatives and program components ✓ Starting small ✓ Core steering committee ✓ Working groups ✓ Multi-level and multidisciplinary stakeholder buy-in ✓ Collaborative culture ✓ Clear communication ✓ Rigorous and credible design ✓ Staggered rollout ✓ Effective program components ✓ Continuous quality improvement ✓ Evidence of success ✓ Long-term sustainability

Barriers

X Lack of capacity and resources X Complexity of cancer care X Unintended opportunity costs X Difficulties engaging healthcare providers X Time-intensive process X Poor communication X Regional variation X Limitations of benchmarks or wait time targets X Sustainability of nurse navigator role X Inadequacy of existing data systems X Other: Lack of wait time data, lack of evidence-based guidelines, difficulty investing time up front, difficulty implementing initiatives that take effect all at once, new pressures on service capacity, difficulty dividing start-up funding between sites, demands on providers’ time, and lack of clear referral criteria

Consider rationale for program development:

✓ Decrease wait times and improve the patient experience X Diagnose cancer earlier and improve long-term survival

Capitalize on experiences and learnings of other jurisdictions.

Recommendations for Alberta

1 2

Pros and cons of our methodological approach

✓ Iterative process ✓ Converging evidence from multiple sources ✓ Included effectiveness data and key informant interviews X Did not conduct full systematic review or economic evaluation, and did not describe all relevant contextual factors X Methodology was not unbiased or comprehensive

Questions?

mpollock@ihe.ca 1.780.448.4881 www.ihe.ca

https://www.ihe.ca/publications/initiatives-to-accelerate-the- diagnostic-phase-of-cancer-care-an-environmental-scan Full report available at:

https://www.cancerresearchuk.org/sites/default/files/cs_report_cwt.pdf http://www.cqco.ca/common/pages/UserFile.aspx?fileId=361713

Examples of programs

Two Week Wait (England, 2000) Three Legged Strategy (Denmark, 2008)